Homelessness and Addiction, Part 1: Why Don’t They Just Get Help?

Last month, Seattle Times columnist Danny Westneat wrote a column that struck a chord with many Seattle residents, particularly those already inclined to believe that people choose to be homeless and addicted to drugs or alcohol. It struck a chord with me, too, although not for the same (or probably the intended) reasons. In the column, Westneat marveled that just a few blocks from the Jungle—the dangerous, massive, unpoliced encampment that stretches along the west side of Beacon Hill—there is a “shelter” that has empty beds every night. (The “shelter” is not actually a shelter, but a long-term Christian rehabilitation center run by the Salvation Army).

“Some shelter beds go empty—even right next to Seattle’s Jungle encampment,” Westneat’s headline roared. “How can this be?,” Westneat wondered. “How can a homeless rehab center next to the city’s most notorious encampment have 10 to 30 empty beds?” Why would anyone in their right mind turn down a “free 60-day stay” in a warm place with food and running water for the dangerous, cold, risky life on offer in a no-man’s land like the Jungle?

This story is an attempt to explain part of how that can be, starting with the difficulties homeless people face on the path toward treatment for drug and alcohol addiction, and ending with the overburdened shelter system itself, including the Salvation Army rehab center. The questions behind the surface Westneat scratches—with more than 400 homeless people living around a freeway overpass nearby, how on earth could these beds be empty?—are deeper and more difficult to answer than such glib incredulity implies. They include: Who “deserves” government-funded services? Why do some people decline services, including treatment? And what obligation do we have to people who can’t or won’t get help but still, because they are people, need a place to lay their heads?

“We’ve got hundreds of beds in the city every night that people don’t want to go to,” Magnolia homeowner George Pierce said at a meeting of the Magnolia Community Council last week. “How do you get these people out from under the Magnolia Bridge who are stealing, leaving human waste, leaving terrible conditions that city officials have done nothing about?”

Those who do outreach to the homeless and work to get them shelter tell a different story. Chloe Gale, co-director of the REACH program at Evergreen Treatment Services, does direct street outreach to encampments. She says that “in general, all of the beds in our shelter system in the city are full all the time.” Although the city opened up 300 new shelter beds as part of the recent emergency declaration on homelessness, Gale says those beds “filled within days, and most shelters end up turning people away” night after night. While some people living in tents or sleeping on bedrolls under freeways are there because they want to be there or can’t go to regular shelters (which generally bar couples, pets, and people who aren’t sober), “I know there are people who really want shelter and are lined up every night and are getting turned away,” Gale says.

Neighborhood Safety Alliance founder Cindy Pierce

Pierce’s wife, Cindy Pierce, is the head of the Neighborhood Safety Alliance, a group made up of homeowners in Magnolia, Queen Anne, and Ballard who oppose the presence of illegal encampments in their neighborhoods. Like many, Pierce draws a bright line between the “deserving” or “truly” homeless who are mentally ill or just down on their luck and those who “choose” to be homeless or continue to depend on drugs and alcohol. “There is a huge difference,” she insisted at a roundtable “Civic Cocktail” discussion hosted by CityClub and Crosscut earlier this month.. “There’s the mental[ly ill], which, we as a society must take care of these people and we must house these people, and the illegal campers out there.”

Despite the views expressed Pierce and many other camp opponents in neighborhoods like Magnolia, the road to treatment and recovery isn’t typically a straight line from a place like the Jungle to a new life as a sober, employable, stably housed member of society. Willpower alone won’t get an addict sober (nor will throwing an addict in jail for a few days), and even addicts who want help end up on long waiting lists for initial intake into treatment programs; by the time their number is up, the window in which they are desperate enough or willing enough or just done enough to want help may have closed.

For many addicts, homeless or not, the first step toward treatment and recovery is detoxification—getting the drug or alcohol out of a person’s system. For alcohol abusers, in particular, detox can be critical: Although many drugs have withdrawal periods that are just more physically unpleasant, only alcohol withdrawal has a relatively high chance of causing a potentially fatal seizure or heart attack, which is why medically supervised detox, with the help of drugs that ease the withdrawal process, is often necessary for chronic drinkers.

But detox beds are in short supply, with wait lists that can stretch weeks or months. If you’re ready change your life starting today, good luck getting into detox even if you do have money; without it, your options are limited to a few behavioral health centers that contract with the county to provide about three dozen beds for low-income patients at facilities in South Park, Kirkland, and Burien. Those 36 beds are the only non-hospital detox beds for Medicaid patients in King County.

King County Health’s behavioral health and recovery division director Brad Finegood says the county knows the beds they have aren’t enough to serve the county at a time when heroin addiction is on the rise and the population is growing. “We are definitely working as hard as we can to build long-term detox capacity,” Finegood says. “We know we need to be able to provide treatment on demand and, when people need treatment, to provide open access.” But they aren’t there yet.

There was another facility in Seattle, run by Recovery Centers of King County—a nonprofit services provider that suddenly closed its doors last year under the shadow of a federal probe and allegations of unpaid wages. The closure of RCKC, which provided 27 beds for low-income addicts, went unmentioned in the local media except by Seattle Weekly, which broke the news of the closure.

But homeless advocates noticed. Gale, of Evergreen Treatment Centers, says RCKC, which offered bare-bones detox and residential treatment out of a modest building on First Hill, was “a critical treatment facility for people that were homeless. It was the main medical detox program for people getting Medicaid funding, and a significant percentage of the population [there] was homeless or formerly homeless. It’s not perfect, but it did its job, and it’s been there for decades.” And now it’s gone.

Finegood says Medicaid rules dictate that detox facilities can’t have more than 16 beds—an unintended consequence of rules designed to prevent the warehousing of mental-health patients—although he says that rule is set to expire in April. Another 20 or 30 beds are coming online at two other facilities later this year, Finegood says—alleviating the problem but hardly serving the needs of an entire, growing county.

And detox, Finegood says, is often the first stop before actual, long-term treatment, either residential or outpatient. “We definitely know and understand that detox is a really key component of getting people into treatment in a number of different ways,” Finegood says. “We engage people into a number of different treatment services.” Treatment, as opposed to detox, is where the long work of recovery often begins, and the process of reacclimating a person who may have been living on the streets, hustling for drugs and barely scraping by, for yours, into straight society.

Timothy Rockey, head of the Salvation Army Adult Rehabilitation Center with which Westneat was so enamored, says that for many, the first barrier to entering the ARC program is that new residents must arrive with a few days’ sobriety under the belts—the ARC doesn’t provide detox. And there are other barriers to entry for programs like the Salvation Army’s, which I’ll describe in more detail in Part 2, which will focus on the advantages and disadvantages of high-barrier and low-barrier approaches to shelter and addiction treatment, later this week.

What about homeless couples? And with service or companion animals? That pretty much describes my husband and I. There is literally nowhere for us to stay. I have a little income from soc sec. He is still struggling with getting out of prison. Guess what? Neither of us drink, do drugs, or have any addictions. We are honest and straightforward about our problems. Doesn’t matter. We have rented places then been thrown out. I’m tired of being judged and lumped in with the rest. And we can’t be the only ones out there.

Cindy Pierce seems to have compassion for the mentally ill: “we as a society must take care of these people and we must house these people”. She puts drug abusers in a different category. What about people with mental illnesses who cope by self-medicating with street drugs. Don’t they also deserve compassion?

Most people abuse substances have trauma histories. However, looking at someone as undeserving means you don’t have to help them. That’s why the “happy hobo” was invented. They want to be homeless so why bother. Meanwhile it is kids, couples and other people who don’t want to stay in shelters because they are full of lice, bedbugs and people steal your stuff.